Meeting and Registration Form

Meeting and Registration Form
National Via de Cristo Gathering 2015
entered
in
Christ
Thursday, July 23 through Sunday July 26, 2015
Augustana College, Rock Island, Illinois 61201
Hosted by Living Water Via de Cristo
“…everyone who thirsts, come to the waters.” Isaiah 55:1
One form per person attending.
Name First
***PLEASE PRINT***
Last
Payment must accompany form.
☐ Male
☐Female
Name for Nametag
Address
City, State, Zip
Home phone
Cell Phone
E-mail Address
Fax
Home Secretariat
Position on Secretariat
Position in 2015
(please check all that apply) ☐ NLS Board Member
Speaker
Lay Delegate
☐ Lay Visitor
☐ Clergy Delegate
☐ Visiting Clergy
First Time attending NLS Annual Meeting/National VdC Gathering ☐Yes ☐No
If no, please indicate last year attended
Position _____________________________
Residence hall is located up a hill from the meeting rooms, about a 7-minute walk. Shuttle service will be
available. Please help us plan! ☐ I require on-site transportation assistance
I require special accommodations for the following: ☐ Medical ☐ Dietary ☐ Physical
Please explain:
Travel to National VdC Gathering will be by ☐Auto ☐Air
I will need to be picked up at MLI ☐Yes ☐No
Transportation will be provided to/from Augustana and Quad City International Airport, Moline, IL (MLI)
You must submit the separate Travel Information Form to make a reservation for airport pick-up
Are you renting a car?
☐Yes ☐No
What day will you be leaving the annual meeting: ☐Saturday PM ☐Sunday by noon
$220.00
_________
_________
_________
_________
_________
_________
Registration fee includes meals, housing, materials Thursday 11:00 a.m. thru Sunday 11:00 a.m.
Early Registration discount -$20 ($200 if mailed before May 1, 2015)
Late Registration +$30 ($250.00 after June 15, 2015)
Double Room Roommate requested: ______________________________________
Single Room requested, additional fee of $45.00 ($15.00 per day)
Extra night on Wednesday (per person) Double $35.00 Single $50.00
Extra meals (total)
(check all that apply) ☐ Wed. Lunch $10 ☐ Wed. Dinner $13 ☐ Thurs. Breakfast $7
DAY RATE $40 per day (includes lunch & dinner) for those not staying on campus
TOTAL
*** MAKE CHECKS PAYABLE TO: 2015 NLSAG-LWVdC
Mail completed Registration Form, Travel Form and Payment to:
VdC National Gathering
c/o Twyla Lingard
2925 15th Ave.
Rock Island, IL 61201
E-mail: [email protected]
Phone: (309) 786-4520
Registration Use Only
Ck rec/number
Transportation
Date Rec
Air Travel Information Form
Via de Cristo National Gathering 2015
entered
in
Christ
Thursday, July 23 through Sunday, July 26, 2015
Augustana College, Rock Island, Illinois 61201
Hosted by Living Water Via de Cristo
“…everyone who thirsts, come to the waters.” Isaiah 55:1
PLEASE PRINT
Name - First
Last
Home Phone
Cell Phone
Work Phone
Fax
E-mail Address
Host Committee will arrange transportation between Augustana College and Quad Cities International Airport.
(approx. 20 minutes to Augustana)
Do you need ADA accessible transportation? ☐Yes ☐No
If yes, please explain:
ARRIVAL:
Date:______________ Arrival Time:____________ Airline:____________________________ Flight #:_________
Departing City: ______________________________________ Departing Airport:_____________________________________
Connecting City: ____________________________________ Connecting Airport:___________________________________
Number of people traveling with you on this flight: ______
Names: _____________________________________________________________________________________________________
DEPARTURE:
Date:______________ Departure Time:____________ Airline:____________________________ Flight #:_________
Number of people traveling with you on this flight: ______
Names: _____________________________________________________________________________________________________
Alternate Travel Options: ACT II Transportation provides shuttle service from Chicago airports to the Quad Cities.
Amtrak passenger train service is available to Galesburg, IL (about 40 miles from the QC). Please contact us for additional
Information. We will do our best to accommodate your travel plans with advance notice.
Note: If there are any changes to your travel arrangements after you send this form,
please e-mail Twyla Lingard at the address below.
Mail completed Registration Form, Travel Form and Payment to:
VdC National Gathering
c/o Twyla Lingard
2925 15th Ave.
Rock Island, IL 61201
E-mail: [email protected]
Phone: (309) 786-4520